MEDICAL SURFARI: NIT PICKERS WANTED

It is that time of the year again and back to school means more infestations by head lice. This can be a burdensome problem but there are some effective, proven solutions for treating this condition. There are also a multitude of reported home remedies that have been tried and many of these lack safeguards or may cause more problems than the lice.

The genus and species of this organism is Pediculus capatis, a small parasitic insect that has almost perfectly adapted to living on the hair of the head and neck of its human host. Head lice have been around for a long time as some have even been recovered from mummies. They have six little legs that are remarkably well adapted to grasping the shafts of hair.

Fortunately these little organisms rarely if ever cause any harm or transmit any infection from one person to another. These lice affect all socioeconomic and ethnic groups although, interestingly, Caucasians are more frequently affected. Also, young children are the most vulnerable to infestation and the dangers associated with abuse of head lice treatments.

Head lice do not fly, dive, jump or pole vault. They are most commonly acquired through direct contact with an infested person or their clothing or bedding. Head lice cause an itchy scalp and sometimes loss of sleep. However, this is not sufficient to make the diagnosis. The diagnosis of lice is made by direct magnified inspection of the scalp as the live lice can be seen and the nits or eggs may also be seen attached to the hair shaft. These lice derive nutrients from blood feeding several times each day and the louse's saliva and feces may irritate the scalp, increasing the chance of a secondary infection.

Treatment involves lousing (sometimes less properly referred to as delousing). This may be done with various chemical treatments directed at killing the lice or by mechanically removing the lice and eggs with a specialized comb. According to the Harvard School of Public Health, "the greatest harm associated with head lice results from the well intentioned but misguided use of caustic or toxic substances to eliminate the lice." People have tried all kinds of remedies including insecticides, essential oils, enzyme treatments, antibiotic treatments, suffocating agents, heat, freezing, haircuts, soap, bleaches, dyes and, if you can believe it, even gasoline. Many of these home remedies lack adequate safeguards and pose some risk to your child. Further, they often have insufficient or no data proving that they are safe and effective.

There has been a shift in the treatment of this condition to promote careful and thorough combing with a specialized comb. One such model is referred to as the "licemeister comb", which is recommended by the National Pediculosis Association. Although the manual removal of lice and nits is time consuming, it has been shown to be effective and without any health risk to your child.

Combing should be done under good light as in natural sunlight and may require the use of a magnifying glass, depending upon your eyesight. First use a grooming comb to remove any tangles, divide the hair in sections and fasten the hair off. Using a specialized comb, go through each section of the scalp dipping the comb into a cup of water and wiping it free of any lice, nits or debris from each comb passing. Look through each group of hair for any persistent nits. This is sometimes easier if you team up with another person. Remove any live lice with tweezers or by "sticking" them with tape that you can double side on your finger. Even with the best of conditions a few lice or nits may be missed and this process may be repeated every day for several days. Being consistent and diligent about the screening and removal will yield the best results. If additional nits (at least three to five per day) are discovered, this may signal the persistence of live lice on the head or a new infestation.

Be wary of alternative treatments for this condition and before trying one, be certain to check with your physician.

World Wide Web Resources

National Pediculosis Association

www.headlice.org/

This is probably the most comprehensive web site on the subject of head lice. It includes information for parents, teachers and day-care providers, as well as teaching materials for children.

Head Lice Information

www.hsph.harvard.edu/headlice.html

The Harvard School of Public Health provides this web page to assist healthcare workers and patients access information relevant to the diagnosis and treatment of head louse infestations.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.